Healthcare Provider Details

I. General information

NPI: 1912417221
Provider Name (Legal Business Name): ALLISON ALYSE RUSSELL RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ALLISON ALYSE MORGAN

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 LAVACA ST STE 110-320
AUSTIN TX
78701-2172
US

IV. Provider business mailing address

1108 LAVACA ST STE 110-320
AUSTIN TX
78701-2172
US

V. Phone/Fax

Practice location:
  • Phone: 512-477-4088
  • Fax: 512-482-0390
Mailing address:
  • Phone: 512-477-4088
  • Fax: 512-482-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number848760
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135235
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: